Article: EMERGENCY MANAGEMENT OF EXTERNAL PROLAPSED HAEMORRHOIDS BY LEECH THERAPY: EVIDENCE BASED CASE SERIES

Article Category: Case Reports

DOI: 10.7897/2277-4343.166203

Pages: 9-16

Author: Dwivedi Amarprakash, Usman Gani Dhange *, Sangale Sanket, Mishra Priyanka

Abstract: External prolapsed haemorrhoid is an acute anorectal condition which often causes significant discomfort and impaired quality of life. In Ayurveda, Acharya Sushruta has advocated the use of Jalaukavacharana (leech therapy) as one of the treatment modalities for the management of Arsha (haemorrhoids). This case series presents three male patients aged 45, 54, and 62 years diagnosed with acute external prolapsed haemorrhoids. Clinical assessment was carried out using the PNR-Bleed classification, Haemorrhoid Severity Score (HSS) and modified Defense and Veterans Pain Rating Scale (DVPRS). All patients underwent leech therapy according to standard protocol, at an interval of 7 days based on severity and clinical assessments were performed on Day 3 and Day 10, followed by a final assessment one week after the last sitting. Supportive oral Ayurvedic medications, including Triphala guggulu, Arogyavardhini vati, and Gandharva haritaki churna, were prescribed throughout the treatment period. Marked symptomatic improvement was observed in all cases, including reduction in pain, bleeding, and prolapse, which is reflected by the progressive decline of PNR-Bleed, HSS scores and DVPR Scale. The findings of this case series highlight the therapeutic potential of leech therapy as a safe, effective, and minimally invasive conservative approach in the management of external prolapsed haemorrhoids. These initial outcomes support its integration into clinical practice for selected cases which are unsuitable for conventional surgical intervention. In order to establish leech therapy as a first line conservative management approach in management of external prolapsed haemorrhoids, exploration through controlled clinical trials with larger sample size are desirable.

Keyword: DVPR Scale, External prolapsed haemorrhoids, Haemorrhoid Severity Score, Jalaukavacharana, Leech therapy, PNR Bleed.